Friday, February 12, 2016

Is there a way to delay menopause... forever?

Women may now be able to stop that biological clock from ticking, thanks to a breakthrough technique that removes a piece of a woman's ovary, to be grafted on later when she wants to have children.

For many women, the ticking of your biological clock can be incredibly stressful. But here's some good news: An international team of researchers presenting at the European Society for Human Reproduction and Embryology in Istanbul this week have pioneered a technique that puts menopause on hold indefinitely, allowing women to put off having children till much later in life. Here, a concise guide to the groundbreaking procedure:

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Why would women want to delay menopause?

If your period marks the official start of "your usefulness as a baby vessel," consider menopause "the long, slow death wail of your fertility," says Cassie Murdoch at Jezebel. But "a woman born today has a 50 percent chance of living to 100." says Dr. Sherman Silber, who has performed the new procedure on 11 women in St. Louis. "That means they are going to be spending half of their lives post-menopause." But now, this procedure gives a woman more time to focus on her career, become financially stable, and perhaps most importantly, allows her to start a family when she chooses to.

How does the new technique was developed?

Dr. Jehoshua Dor, a professor of obstetrics and gynecology at the Sackler School of Medicine in Tel Aviv University, Israel and an internationally respected researcher, long ago theorized on how a woman can freeze a piece of her ovary while she is young and have it replaced in perimenopause to avoid going through menopause and never need to take hormones. But recently, he has actually developed a ground-breaking method to restore fertility in patients who went through menopause due to chemotherapy. These women were in their 30s and 40s and wanted to have children in the future. To preserve their fertility, Dr. Dor performed a laparoscopy and took a small piece of tissue from the ovary and cut it into strips and froze those strips so that it could be replaced back into the woman's ovary via laparoscopy after she recovered from her disease.

Following replacement of the ovarian tissue, the women's menopause reversed and they began to menstruate and develop functional ovaries that could produce both eggs and estrogen. The first women to deliver a baby with the help of in vitro fertilization by using her own ovarian tissue after being in menopause was published in the New England Journal of Medicine.

Dor and his team realized that several years after the operation, the women were still producing hormones. In some cases they also were able to become pregnant again even without the help of in vitro fertilization. To date, 30 babies have been born by this method and half conceived on their own without fertility treatment. No other hormones were necessary.

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How much time does the procedure buy?

Theoretically, a woman could have kids well into old age, as long as she is physically able to carry a baby to term. "You could have grafts removed as young women, and then have the first replaced as you approach menopausal age," says Dr. Silber. "You could then put a slice back every decade." So far, transplants carried out eight years ago are still working. "It's really fantastic," he says. "We didn't expect a little piece of ovarian tissue to last this long."

Are there any side effects?

Yes, both positive and negative. First, the good: Women can avoid the "increased risk of osteoporosis and heart disease that come with the end of their fertile life," says Stephen Adams. But there are also downsides: The technique may raise a woman's risk of breast and womb cancer due to having higher estrogen levels later in life.

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When could the technique be widely employed?

In a paper published 2012 in the journal Molecular Human Reproduction, Dr Silber wrote: “All modern women are concerned about what is commonly referred to as their ‘biological clock’ as they worry about the chances of conceiving by the time they have established their career and/or their marriage and their financial stability.

"Most of our cured cancer patients, who have young ovarian tissue frozen, feel almost grateful they had cancer, because otherwise they would share this same fear all modern, liberated women have about their ‘biological clock'."

The first operation, conducted on Oudara Touirat in Belgium in 2003, led to a pregnancy and successful birth a year later. Strips of her ovarian tissue were removed before chemotherapy for Hodgkin's lymphoma and were replaced after she was given the all clear.

In 2008, The Daily Telegraph revealed that Susanne Butscher, who received a whole ovary transplant in a world first from her twin sister, had given birth to a daughter, named Maja. Mrs Butscher, then 39, had gone through the menopause early. Dr Silber carried out the operation in 2007 and 13 months later it was confirmed she had conceived naturally.

All the women who have undergone the procedure have had cancer but doctors said it was now time to extend it to others. Dr Gianluca Gennarelli, a Turin-based gynecologist involved in the Italian case, said in time it should be made available to women with other conditions - including those likely to suffer early menopause due to family history.

He said: “In the 21st century many women don't want to have children until they are in their 30s, rather than at 18. But if your mother went through menopause before 40 that could be very difficult.”
Stuart Lavery, head of IVF at Hammersmith Hospital in London, said the findings showed ovarian transplants could last a lot longer than previously thought.

Previous studies had shown some only had “a very finite lifespan” of six to nine months, meaning women having to have repeat operations. Tim Hillard, a gynecologist and trustee of the British Menopause Society, said the technique was 'exciting'.

He said: "This is an exciting developing as a fertility treatment, however we would need much more data before claims could be made about the menopause. You would have to balance it very carefully, the higher risks of breast and womb cancer that go with having estrogen circulating for longer against the increased risk of heart disease, osteoporosis and maybe dementia that go with the menopause.
"Theoretically it could be used as an alternative to hormone replacement therapy, particularly in women who go through the menopause prematurely, but that could be ten or 15 years away."

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